What is superior in management of GAVE: Endoscopic band ligation versus argon plasma coagulation versus combined therapy?

Abstract

Background: Gastric antral vascular ectasia (GAVE) is a condition characterized by abnormal blood vessel growth in the stomach’s antrum, leading to gastrointestinal bleeding. Treatment options typically include endoscopic band ligation (EBL) and argon plasma coagulation (APC), but their combined efficacy has not been thoroughly investigated.
Objective: To compare the effectiveness of EBL, APC, and a combined EBL + APC approach in treating GAVE.
Patients and Methods: A total of 75 patients with GAVE were enrolled and divided into three groups: Group I (EBL, n=25), Group II (APC, n=25), and Group III (Combined EBL + APC, n=25). Each patient underwent endoscopic treatment according to their group assignment. Pre- and post-treatment evaluations included hemoglobin levels, platelet counts, total leukocyte counts, and the presence of occult blood in stool. Follow-up assessments were conducted at 3 weeks and at 3 and 9 months to monitor recurrence and overall improvement.
Results: The combined EBL + APC approach demonstrated superior outcomes compared to EBL or APC alone. Hemoglobin levels increased significantly more in Group III (10.60 ± 0.32 g/dl) than in Groups I (9.00 ± 0.52 g/dl) and II (9.55 ± 0.20 g/dl). Additionally, Group III showed a significant reduction in recurrence rates and better endoscopic results. Statistical analysis revealed significant differences in hemoglobin levels and recurrence rates between the combined and individual treatment groups (P < 0.001 for all comparisons).
Conclusion: The combined EBL and APC approach is more effective in managing GAVE, leading to better clinical outcomes and fewer complications. Further research using greater sample sizes and extended follow-up are needed to confirm these findings and potentially establish this combined method as a standard treatment for GAVE.